Sentinel surveillance of suspected opioid-related poisonings and injuries: trends and context derived from the electronic Canadian Hospitals Injury Reporting and Prevention Program, March 2011 to June 2017. / Surveillance des cas suspectés d'intoxication et de blessures liées aux opioïdes : tendances et contexte tirés du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, mars 2011 à juin 2017.

INTRODUCTION: The opioid epidemic is currently a major public health problem in Canada. As such, knowledge of upstream risk factors associated with opioid use is needed to inform injury prevention, health promotion and harm reduction efforts. METHODS: We analyzed data extracted from 11 pediatric and 6 general hospital emergency departments (EDs) as part of the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) from March 2011 to June 2017. We identified suspected opioid-related injuries using search strings and manually verified them. We computed age-adjusted and sex-stratified proportionate injury ratios (PIRs) and 95% confidence intervals (CIs) to compare opioid-related injuries to all injuries in eCHIRPP. Negative binomial regression was used to determine trends over time. We conducted qualitative analyses of narratives to identify common themes across life stages. RESULTS: Between March 2011 and June 2017, 583 suspected opioid-related poisoning/ injury cases were identified from eCHIRPP. Most of the cases were females (55%). Many of the injuries occurred in patients' own homes (51%). Forty-five percent of the injuries were intentional self-harm. Among children (aged 1-9 years), most injuries were caused by inadvertent consumption of opioids left unattended. Among youth (aged 10-19 years) and adults (aged 20-49 years), opioid use was associated with underlying mental illness. Overall, the average annual percent change (AAPC) in the rate of injuries (per 100 000 eCHIRPP cases) has been increasing since 2012 (AAPC = 11.9%, p < .05). The increase is particularly evident for males (AAPC = 16.3%, p < .05). Compared to other injuries, people with suspected opioid-related injuries were more likely to be admitted to hospital (PIR = 5.3, 95% CI: 4.6-6.2). CONCLUSION: The upstream determinants of opioid-related injuries are complex and likely vary by subpopulations. Therefore, continued monitoring of risk factors is important in providing the evidence necessary to prevent future overdoses and deaths.

INTRODUCTION: La crise actuelle des opioïdes est un problème de santé publique majeur au Canada. Il est nécessaire de connaître les facteurs de risque en amont associés à la consommation d'opioïdes pour éclairer les efforts de prévention des blessures, de promotion de la santé et de réduction des méfaits. MÉTHODOLOGIE: Nous avons analysé les données sur les blessures subies par des personnes traitées dans les services d'urgence (SU) de onze hôpitaux pédiatriques et de six hôpitaux généraux au Canada et recueillies par le Système canadien hospitalier d'information et de recherche en prévention des traumatismes en ligne (SCHIRPTe) entre mars 2011 et juin 2017. Nous avons identifié les blessures apparemment liées aux opioïdes au moyen de chaînes de recherche et nous les avons vérifiées manuellement. Nous avons calculé des rapports proportionnels de blessures (RPB) en fonction de l'âge et du sexe ainsi que des intervalles de confiance à 95 % pour comparer les blessures liées à la consommation d'opioïdes à l'ensemble des blessures figurant dans le SCHIRPTe. Une régression binomiale négative a été utilisée pour déterminer les tendances au fil du temps. Nous avons effectué des analyses qualitatives des informations descriptives afin d'en dégager les thèmes communs spécifiques à chaque étape de vie. RÉSULTATS: Nous avons identifié 583 cas d'intoxications ou de blessures apparemment liées aux opioïdes dans le SCHIRPTe pour la période allant de mars 2011 à juin 2017. La majorité concernaient des femmes (55 %) et sont survenues au domicile des patients (51 %). Quarante-cinq pour cent des blessures étaient des automutilations intentionnelles. Chez les enfants (1 à 9 ans), la plupart des blessures ont été causées par une consommation accidentelle d'opioïdes laissés sans surveillance. Chez les jeunes (10 à 19 ans) et les adultes (20 à 49 ans), la consommation d'opioïdes était associée à une maladie mentale sous-jacente. Dans l'ensemble, on observe une augmentation de la variation annuelle moyenne en pourcentage (VAMP) du taux de blessures (pour 100 000 cas dans le SCHIRPTe) depuis 2012 (VAMP = 11,9 %, p < 0,05), particulièrement marquée chez les hommes (VAMP = 16,3 %, p < 0,05). Les personnes victimes de blessures apparemment liées à la consommation d'opioïdes étaient plus susceptibles d'être admises à l'hôpital que les personnes victimes d'autres types de blessure (RPB = 5,3, IC à 95 % : 4,6 à 6,2). CONCLUSION: Les déterminants en amont des blessures liées à l'utilisation d'opioïdes sont complexes et varient probablement selon les sous-populations. La surveillance continue des facteurs de risque est donc importante afin d'obtenir les données probantes nécessaires à la prévention d'autres surdoses et décès.

A review of findings from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS).

OBJECTIVE: This article critically assesses and reviews analyses derived from three cycles of the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS) published between 2001 and October 2011. METHODS: Articles were retrieved from the Public Health Agency of Canada's data request records, which tracked database access and ensuing publications. The included articles were reviewed and appraised independently by the authors. SYNTHESIS: Overall, 37 peer-reviewed articles using CIS data were included in the review. These articles revealed an increased likelihood of substantiation or placement if investigations 1) uncovered the presence of emotional or physical harm in a child, 2) involved older children, 3) identified the presence of risk indicators in caregivers, or 4) documented unstable or unsafe housing. A similar proportion of articles used a descriptive or multivariate approach to analyze CIS data, and strengths and limitations were identified. CONCLUSION: Researchers have analyzed and interpreted the CIS extensively, although several issues are understudied - such as neglect and emotional maltreatment - especially using multivariate approaches. We hope this review will contribute to helping address gaps in the CIS literature.

The burden of adult obesity in Canada.

Obesity is a major public health problem associated with a wide range of health problems. This study estimates the prevalence of obesity, calculates the proportion (or population-attributable fraction [PAF]) of major chronic diseases which is attributable to obesity, estimates the deaths attributable to it and projects its future prevalence trends. In Canada, the overall age-standardized prevalence proportion of obesity has increased from 10 percent in 1970 to 23% in 2004 (8 percent to 23 percent in men and 13 percent to 22 percent in women). The increasing prevalence of obesity was observed for all five age groups examined: 20-34, 35-44, 45-54, 55-64 and 65+. On average, the PAF of prevalence of selected major chronic diseases which is attributable to obesity from 1970 to 2004 has increased by 138 percent for men and by 60 percent for women. Overall, in 2004, 45 percent of hypertension, 39 percent of type II diabetes, 35 percent of gallbladder disease, 23 percent of coronary artery diseases (CAD), 19 percent of osteoarthritis, 11 percent of stroke, 22 percent of endometrial cancer, 12 percent of postmenopausal breast cancer, and 10 percent of colon cancer could be attributed to obesity. In 2004, 8,414 (95 percent CI: 6,881-9,927) deaths were attributable to obesity. If current obesity prevalence trends remain unchanged, the prevalence proportion of obesity in Canada is projected to reach 27 percent in men and 24 percent in women by the year 2010. These increases will have a profound impact on the treatment needs and prevalence of a wide variety of chronic diseases, and also on the health care system in terms of capacity issues and resource allocation.

Adolescent injury deaths and hospitalization in Canada: magnitude and temporal trends (1979-2003).

PURPOSE: To understand the magnitude and the national trends of mortality and hospitalization due to injuries among Canadian adolescents aged 15-19 years in 1979-2003. METHODS: Data on injury deaths and hospitalizations were obtained from the national Vital Statistical System and the Hospital Morbidity Database. Injuries were classified by intent and by mechanism. RESULTS: In 15-19-year-olds, 75.6% of all deaths and 16.6% of all hospitalizations were attributed to injuries. Unintentional and self-inflicted injuries accounted for 70.2% and 24.1%, respectively, of total injury deaths as well as 72.6% and 17.4%, respectively, of total injury hospitalizations. The main causes for injury were motor vehicle traffic-related injury (MVT), suffocation, firearm, poisoning, and drowning for injury deaths; and MVT, poisoning, fall, struck by/against, and cut/pierce for injury hospitalizations. Mortality and hospitalization rates of total and unintentional injuries decreased substantially, whereas those of self-inflicted injuries decreased only slightly, with a small increase in females. Rates also decreased for all causes except suffocation, which showed an increasing trend. Males had higher rates for all intents and causes than females, except for self-inflicted injury hospitalization (higher in females). The territories and Prairie Provinces also had higher ones of total injuries and self-inflicted injuries than in other provinces. CONCLUSIONS: Injury is the leading cause of deaths and a major source of hospitalizations in Canadian adolescents. However, prevention programs in Canada have made significant progress in reducing injury mortality and hospitalization. The graduated driver licensing, enforcement of seat-belt use, speed limit and alcohol control, and Canadian tough gun control may have contributed to the decline.

Trends in mortality from ischemic heart disease in Canada, 1986-2000.

This study examined trends in ischemic heart disease (IHD) mortality rates in Canada from 1986 to 2000, including analyses at the county level. The study population comprised Canadians aged 35 and over. Age-standardized mortality rates (ASMRs) were computed. Linear regression and Poisson regression were used to calculate average annual percentage change (AAPC) by age, sex, county and province. A substantial decrease in mortality rates was observed in those aged 35 and over for both sexes; the AAPC indicated a decline of 3.44 percent for males and 3.42 percent for females. The ASMRs were plotted for three time periods; the rates increased with each successive age group and decreased with each consecutive time period for both sexes. A significant decline in the IHD mortality rate was found in 47.2 percent and 46.9 percent of the counties among males and females, respectively; those counties had a statistically significant lower prevalence of daily smoking in both genders, and obese in females only. Only two counties showed a significant increase in the ASMRs of IHD in males and females, respectively. Enhanced prevention and control strategies should be considered to address IHD in countries where more modest decreases (or no decrease at all) in IHD mortality have been observed.

Mortality among Canadian women with cosmetic breast implants.

There is widespread concern about possible long-term health effects among women who have received breast implants for cosmetic purposes; few studies have reported on the mortality patterns of such women. The authors examined cause-specific mortality in a cohort of 24,558 women with breast implants and 15,893 women who underwent other plastic surgery procedures in Ontario and Quebec, Canada, between 1974 and 1989. Deaths through 1997 were identified through linkage to the national mortality database. The authors compared the mortality of women who received implants with that of the general population by using standardized mortality ratios; Poisson regression was used to perform internal cohort comparisons. Overall mortality was lower among women who received breast implants relative to the general population (standardized mortality ratio = 0.74, 95% confidence interval: 0.68, 0.81). In contrast, higher suicide rates were observed in both the implant (standardized mortality ratio = 1.73, 95% confidence interval: 1.31, 2.24) and other plastic surgery (standardized mortality ratio = 1.55, 95% confidence interval: 1.07, 2.18) patients. No differences in mortality were found between the implant and other surgeries group for any of the 20 causes of death examined. Findings suggest that breast implants do not directly increase mortality in women. Further work is needed to evaluate risk factors for suicide among women who undergo elective cosmetic surgery.

Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation.

The possibility that women, who receive breast implants for cosmetic purposes, have increased long-term risks of developing cancer continues to be debated. The objective of our study was to prospectively examine cancer incidence among women who received breast implants. A cohort was assembled of 24,558 women, 18 years of age and older, who underwent bilateral cosmetic breast augmentation, and 15,893 women who underwent other cosmetic procedures in Ontario or Quebec between 1974 and 1989. These plastic surgery patients were selected from the same clinics as the implant population. Incident cancers were identified by linking to Canadian registry data up to December 31, 1997. In total, 676 cancers were identified among women who received breast implants compared to 899 expected based on general population rates (standardized incidence ratio (SIR) = 0.75; 95% confidence interval (CI) = 0.70-0.81). Overall cancer incidence rates among women who received breast implants were similar to that of the other plastic surgery patients (relative risk (RR) = 0.91, 95% CI = 0.81-1.02). However, women who received breast implants had lower breast cancer rates than the plastic surgery patients (RR = 0.64, 95% CI = 0.53-0.79). No increased risks were observed among the implant population for any of the other cancer sites examined. Comparisons involving only women who received breast implants found no association between long-term breast cancer incidence and implant site (submuscular vs. subglandular), fill (saline vs. silicone) or envelope (polyurethane-coated or not). In conclusion, women undergoing cosmetic breast augmentation do not appear to be at an increased long-term risk of developing cancer.

Physical activity, obesity, energy intake, and the risk of non-Hodgkin's lymphoma: a population-based case-control study.

The authors conducted a population-based case-control study of 1,030 cases with histologically confirmed, incident non-Hodgkin's lymphoma (NHL) and 3,106 controls to assess the impact of recreational physical activity, obesity, and energy intake on NHL risk in Canada from 1994 to 1997. Compared with those for subjects in the lowest quartiles of total recreational physical activity, multivariable-adjusted odds ratios for subjects in the highest quartile were 0.79 (95% confidence interval (CI): 0.59, 1.05) for men and 0.59 (95% CI: 0.42, 0.81) for women. Obesity (body mass index > or = 30 kg/m2) was associated with odds ratios of 1.59 (95% CI: 1.18, 2.12) for men and 1.36 (95% CI: 1.00, 1.84) for women. For men and women with a lifetime maximum body mass index of > or = 30 kg/m2, respective odds ratios were 1.55 (95% CI: 1.16, 2.06) and 1.10 (95% CI: 0.83, 1.46). For men and women in the highest quartiles of calorie intake, respective odds ratios were 1.95 (95% CI: 1.45, 2.62) and 1.13 (95% CI: 0.84, 1.52). Some differences were found between histologic subtypes of NHL for these associations. This study suggests that recreational physical activity decreases NHL risk, while obesity and excess calorie intake increase it. More studies are needed to confirm these results, especially the differences between histologic subtypes.

Trends in mortality from diabetes mellitus in Canada, 1986-2000.

The purpose of this study was to examine trends in diabetes mellitus (DM) mortality rates in Canada, including analysis at the provincial level, during the period 1986-2000. The study population included Canadians aged 35 and over. Age-standardized mortality rates (ASMRs) were computed. Linear regression was used to calculate the average annual percentage change (AAPC) by age, sex and province. The results showed a substantial increase in DM mortality rates among those aged 35 and over, particularly for men; the AAPC indicated an increase of 2.4% for men and 0.7% for women. When the mortality rates were plotted for three time periods, the rates increased with each successive age group and period for both sexes. Mortality from DM increased significantly in both sexes in Canada between 1986 and 2000, particularly in men.

Occupational risk factors for brain cancer in Canada.

OBJECTIVE: We sought to examine the impact of occupational exposure on brain cancer risk. METHODS: Mailed questionnaires were used to collect information on lifetime employment history, occupational exposure to 18 chemicals, and other risk factors for 1009 incident cases of brain cancer and 5039 control subjects in Canada in 1994 to 1997. RESULTS: People exposed to asphalt and welding had respective odds ratio (and 95% confidence interval) of 1.29 (1.02-1.62) and 1.26 (0.98-1.45). An increased risk of brain cancer might be associated with exposure to asbestos, benzene, mineral or lubricating oil, isopropyl oil, and wood dust and with following occupations: teaching; protective service; metal processing and related jobs, and metal shaping and forming; knitting in textile processing; construction trades; and transport equipment operating. CONCLUSIONS: Our study suggests a possible role for occupational exposure in the etiology of brain cancer.

Physical activity and the risk of ovarian cancer: a case-control study in Canada.

We evaluated the impact of recreational and occupational physical activity on ovarian cancer risk using data from a population-based case-control study of 442 cases with histologically confirmed incident ovarian cancer and 2,135 controls aged 20-76 years, conducted in 1994-1997 in Canada. Frequency and intensity of physical activity were collected through self-administered questionnaires. Compared to women in the lowest tertiles of moderate, vigorous and total recreational activity, those in the highest tertiles had multivariable-adjusted odds ratios (and 95% confidence intervals) of 0.67 (0.50-0.88), 0.93 (0.70-1.24) and 0.73 (0.58-0.98), respectively. There were statistically significant trends of decreasing risk with increasing levels of moderate and total recreational activity, with similar patterns for premenopausal and postmenopausal women. A significant reduction in risk associated with higher level of moderate recreational activity was observed for serous, endometrioid and other but not mucinous types of tumors. The analyses in one province with the largest number of cases and controls indicated that occupational activity was associated with reduced ovarian cancer risk by lifetime activity and by various life periods (early 20s, early 30s, early 50s and 2 years before interview). Our study suggests that occupational and regular moderate recreational physical activity reduce ovarian cancer risk.

Active and passive smoking and risk of renal cell carcinoma in Canada.

This study aimed to assess the role of active and passive smoking in the development of renal cell carcinoma (RCC). Mailed questionnaires were completed by 1279 incident RCC cases and 5370 population controls between 1994 and 1997 in eight Canadian provinces. Data were collected on socio-economic status, smoking habits, diet and passive smoking status, as well as residential and occupational history. The study found an increased risk of RCC associated with active smoking. Elevated risk of RCC was also observed with passive smoking; compared with those never exposed to either passive or active smoking, men and women with 43 or more years of passive residential and/or occupational exposure had respective adjusted Odds Ratios (ORs) of 3.9 (95% Confidence Interval (CI) 1.4-10.6) and 1.8 (95% CI 1.0-3.3) (P=0.001 and P=0.09, respectively). Both active and passive smoking might play a role in the aetiology of RCC.

Occupational exposure to chemical and petrochemical industries and bladder cancer risk in four western Canadian provinces.

Occupational factors have been proposed to play a critical role in bladder cancer. This population-based case-control study was conducted to confirm the association between selected occupational and non-occupational risk factors and risk of bladder cancer using data collected from the four western Canadian provinces. Unconditional logistic regression analyses were based on 549 histologically confirmed bladder cancer cases and 1099 controls. Bladder cancer risk was found to increase with increasing pack-years of cigarette smoking with an odds ratio (OR) in the highest quartile of 3.32 (95% confidence interval [CI], 2.28-4.82). A dose-response relationship was demonstrated between bladder cancer and pack-years of smoking (p < 0.0001). A positive trend was observed with coffee consumption in men (p < 0.0001), with the highest risk in the highest category of exposure: drinkers of four cups or more per day had an OR of 1.77 (95% CI 1.11-2.82). Increased bladder cancer risk was associated with self-reported exposure at work to several chemicals: asbestos (OR 1.69 [95% CI 1.07-2.65]); mineral, cutting or lubricating oil (1.64 [95% CI 1.06-2.55]); benzidine (2.20 [95% CI 1.00-4.87]). The population attributable fraction (PAF) estimates were 51% for cigarette smoking, 17% for heavy coffee consumption, 10% for mineral, cutting or lubricating oil exposure, 6% for asbestos exposure, and 1% for benzidine exposure. Although self-reported chemical exposures have important limitations, the findings are suggestive of increased risk for several associations previously reported between chemical agents or industries and risk of bladder cancer.

A case-control study of diet and the risk of ovarian cancer.

Epidemiologic studies have suggested that some dietary factors may play a role in the etiology of ovarian cancer, but the findings have been inconsistent. We assessed the association of ovarian cancer with dietary factors in a population-based case-control study in Canada. Diet information was collected on 442 incident cases of ovarian cancer diagnosed in 1994 to 1997 and 2,135 population controls via a self-administered questionnaire. Compared with women in the lowest quartile of cholesterol intake, those in the second, third, and fourth quartiles had a multivariate adjusted odds ratio [OR; 95% confidence interval (95% CI)] of 1.12 (0.81-1.56), 1.20 (0.85-1.68), and 1.42 (1.03-1.97), respectively (P for trend = 0.031). Higher egg consumption was also associated with a nonsignificant increase in ovarian cancer risk. The ORs (95% CIs) for ovarian cancer were 0.77 (0.60-1.04) and 0.76 (0.56-0.99) among women in the highest quartile of total vegetable and cruciferous vegetable intake as compared with women in the lowest quartile. Women who took supplements of vitamin E, beta-carotene, and B-complex vitamins for > or =10 years had ORs (95% CIs) of 0.49 (0.30-0.81), 0.31 (0.11-0.91), and 0.61 (0.36-1.05), respectively. However, we did not observe an association of ovarian cancer risk with dietary fat intake, including saturated, monounsaturated, and polyunsaturated fatty acids, protein, carbohydrate, dietary fiber, fruit, dairy products, meat products, fish, chicken, grain products, nut products, baked desserts, margarine, butter, mayonnaise, and supplement of multiple vitamins, vitamin A, vitamin C, calcium, iron, zinc, and selenium. Our findings suggested that ovarian cancer risk was positively associated with higher consumption of dietary cholesterol and eggs and inversely associated with higher intake of total vegetables and cruciferous vegetables and supplementation of vitamin E, beta-carotene, and B-complex vitamins.

Association of cigarette smoking with the risk of ovarian cancer.

Cigarette smoking may be associated with ovarian cancer risk. This association may differ by histological type. The authors conducted a population-based case-control study in Canada of 442 incident cases of ovarian cancer and 2,135 controls 20-76 years of age during 1994-1997 to examine this association, overall and by histological type. Compared to women who never smoked, those who smoked had higher odds (odds ratio [OR] = 1.22; 95% confidence interval [CI] = 0.98-1.53) of having ovarian cancer, and the OR was larger for ex-smokers (1.30; 95% CI = 1.01-1.67) than for current smokers (1.10; 95% CI = 0.81-1.49). The association with cigarette smoking was stronger for mucinous tumors (OR = 1.77; 95% CI = 1.06-2.96) than for nonmucinous tumors (OR = 1.13; 95% CI = 0.89-1.44). In addition, the odds of smokers having mucinous tumors increased with years of smoking (OR = 1.36, 1.88, 1.19, 4.89 for <20, 21-30, 31-40 and >40 years, respectively; p for trend = 0.002), number of cigarettes smoked per day (OR = 1.55, 1.89, 2.28 for <10, 11-20 and >20 cigarettes/day, respectively; p for trend = 0.014) and smoking pack-years (OR = 1.13, 2.65, 1.77 and 2.39 for <10, 11-20, 21-30 and >30 pack-years, respectively; p for trend = 0.004). Our data suggest that cigarette smoking is associated with an increased risk of ovarian cancer, especially for mucinous types.

Cancer incidence patterns among Chinese immigrant populations in Alberta.

This study examines the incidence of cancer among Chinese immigrants to Alberta in comparison to the incidence in Canadian-born Alberta residents and in people of Chinese origin still living in China. Cancer cases among Chinese immigrants and Canadian-born Alberta residents were identified from the Alberta Cancer Registry (1974-1993). Incidence rates for Shanghai (1975-1992) were obtained from the International Agency for Research on Cancer (IARC) publications. Direct age-standardized incidence rates (ASIRs) were calculated using the "world standard population." Descriptive analysis and Poisson regression modelling were employed to obtain the rate ratios for certain cancer sites among the three populations. For males, the overall incidence of cancer (excluding non-melanoma skin cancer) was lowest in Chinese immigrants while being similar in Canadian-born Alberta residents and Chinese living in Shanghai (197 vs. 224 and 232/100,000). For females, the overall incidence in Chinese immigrants was lower than Canadian-born Alberta residents but similar to that in Chinese living in Shanghai (154 vs 200 and 150/100,000). For cancers that are common in China (stomach and esophagus), the incidence rates for Chinese immigrants were more similar to those for Canadian-born residents than to rates for Shanghai. However, the incidence of liver cancer was very high in the immigrants, suggesting the possible presence of an initiating event during childhood or early adulthood. For cancers that are traditionally uncommon in China (breast and prostate), rates for immigrants were mid-way between those of the two comparison groups. This study supports observations that the risk of cancer in immigrants tends towards the risk of people in the new host country.